Higher dosages have been leaving me breathy for 3+weeks and then the spasms have started right away. I am hoping that this new approach will shorten the breathiness while giving me some good quality voice time that I have been missing.

Anyone tried this type of approach before?

For me, the only way out of it was to go unilateral, so that one cord was functional, and the other weak - to control the SD. I am currently very satisfied with my treatment regime - which is unilateral (2 sites in right cord only) and 10 units every 6 months.

Good luck

What is more important, to me anyway, is that the SAME cord is injected each time. When I tried unilateral but alternating cords - ie left/right/left/right .... then I found the uninjected cord was still fairly weak from the previous injection and I was still too breathy. Another advantage with unilateral injections is that a higher dose can be used and this, in my opinion, means the shot lasts longer. A slight refinement to this unilateral approach is that my doctor injects two sites in the right cord - this spreads the Botox around more and acts as an insurance policy in case one shot is in the wrong place.

I also had severe (6+ weeks) breathiness issues with my bilateral botox injections. I lowered the dose down to about 1 unit bilaterally and was still initially voiceless and then very breathy for over 6 weeks... then I would get about 3 weeks of relief at most! The voicelessness/breathiness was almost worse than the SD itself.

I recently switched to unilateral (one-sided) injections and so far I'm quite satisfied with the results. I have very little breathiness and the injections last just as long. My voice quality (during the "normal voice" period) is also better w/ unilateral injections. I've had two successful unilateral injections so far and plan to continue with this approach in the future.

The most I have ever gotten was 2.5 units each side.

Thanks, you have given me something to look forward to with my next treatment.

My first unilateral injection was 2.5 units (May 2002).... and the one I just had a month ago was 6 units. I am considering going higher next time as I basically had no breathy side effects this time and perhaps a higher dose would last even longer. But I will play it by ear pending the outcome/duration of this injection which, so far, has been good.

I get bilateral injections every 8-10 weeks with 0,3 U in each cord and I am essentailly always free of symptoms. I understand that their bilateral doses vary from 0,2U to 3,0U, the unilateral doses are much larger as described in the message from David Barton.

In my first treatment I got 1,25U in each cord, wich made me voiceless for 4 weeks and breathy for another 3 weeks. From that experiment they knew that I should have a very small dose.

Good luck in your experimenting!

Try using the search function on this board .... click on search, and enter "SLAD" and if you enter a period of 180 days you will obtain over 30 posts.

SLAD stands for selective laryngeal adductor denervation. The technique was pioneered by Dr Gerald Berke ("Berke" is another term to search for, BTW) and he spoke about it at some length at the NSDA Symposium in Scottsdale, AZ in March this year. If you want to read a transcript, take a look at www.dystonia-support.org and click on "Symposium reports".

The surgery seems to work best for uncomplicated AD/SD. Like any major surgery it should not be undertaken lightly. There is little information about long-term results, but many of the people that have had the surgery are very pleased with it so far. Balance that with the fact that at least two males have ended up with no voice, at all, after the surgery.

In my 25 shots (all unilateral), I've graduated from 7 units down to 3. The lower dosage does give a shorter breathy period, 3 or so weeks as opposed to 5 or 6, but the overall cycle lasts the same--four months, give or take a few days. For me at least, lower dosage works as well and doesn't result in higher frequency.

As for where the shot is placed, my doctor has me say "eeeeee", which apparently identifies the correct location. Others can probably explain this better than I can, but I've never had a bad shot.